George Grossberg, MD

"Outside of falls, [neuropsychiatric symptoms] are the No. 1 most common reason why dedicated families who love and take care of their loved one with a neurodegenerative disease throw in the towel and say, ‘I can’t do it anymore.’ Because of the impact of the neuropsychiatric symptoms like psychosis, which can often trigger agitated and even overtly aggressive behaviors."

For patients with neurodegenerative conditions, on top of their typical cognitive impairments, they may suffer from a wide range of neuropsychiatric symptoms, including agitation, irritability and impulsivity, apathy and indifference, and much more. They may demonstrate socially inappropriate behaviors such as changes in eating behavior, or stereotyped behaviors such as pacing, wandering, and rummaging. These symptoms may be underrecognized even though some patients consider them even more impactful than their motor symptoms.

, Samuel W. Fordyce professor and director, Geriatric Psychiatry, St Louis University School of Medicine, has harped on the need for recognition and awareness of neuropsychiatric symptoms. He noted that these can not only cause serious detriment to a patient’s quality of life but are among one of the most distressing symptoms to handle for families and caregivers. Grossberg, an expert in geriatric psychiatry, was a senior author of a recently published paper on using telehealth to manage neurodegenerative conditions, with several aspects of the recommendations tied to things like a team-based approach and asking relevant questions.

®, Grossberg discussed why the clinical community needs to continue to raise the awareness of neuropsychiatric symptoms and the impact they have on patients with neurodegenerative diseases. He highlighted research he previously conducted called the A-B-Cs of neurodegenerative brain diseases, which emphasize activities of daily living, behavior, and cognition.

1. Shaughnessy L, Brunton S, Chepke C, Farmer JG, Rosenzweig AS, Grossberg G. Using telemedicine to assess and manage psychosis in neurodegenerative diseases in long-term care. 

Published online January 12, 2022. doi:10.1016/j.jamda.2021.12.033

Videos

The director of Geriatric Psychiatry at the St Louis University School of Medicine discussed the need to improve awareness of the signs of psychiatric-related symptoms and to eliminate the stigmas associated with them. [WATCH TIME: 3 minutes]

Raising Awareness of Neuropsychiatric Symptoms in Neurodegenerative Diseases: George Grossberg, MD

"Everybody plays a role. We bring all these people together to figure out what’s going on with this particular individual, and what can we do to help. Whether its nonpharmacologic interventions, or at times, the necessary pharmacologic therapies, to improve the quality of life of that vulnerable patient and his or her care partners or caregivers."

Telemedicine offers a unique set of advantages for residents in long-term care (LTC) facilities if effectively supported and implemented, including expanded access to specialists in rural or underserved areas or for people with dementia who cannot travel for off-site visits. In late 2020, a multidisciplinary consensus panel was convened to collate a list of best practices for LTC facilities and specialists when conducting telemedicine with residents with dementia-related psychosis or Parkinson disease-related psychosis (PDP).

Of the recommendations included, a team-based approach was heavily emphasized. This begins at the administrative level, where acceptance by administrators sets a positive tone regarding the use of telemedicine, and thereby, empowers staff in resident care to participate in and support telemedicine visits. The authors also stressed the importance of team members recognizing psychosis-like symptoms, responding to needs and questions, and remaining readily available to the primary care physician in emergency situations.

, feels as though these team-based approaches to telemedicine should be applied in all LTC facilities that house patients with neurodegenerative disorders. Grossberg, the Samuel W. Fordyce professor and director of Geriatric Psychiatry at St Louis University School of Medicine, sat down to discuss this specific recommendation, the roles specialists and caregivers play, and the questions that need to be asked when evaluating patients for neuropsychiatric symptoms.

The Samuel W. Fordyce professor and director of Geriatric Psychiatry at the St Louis University School of Medicine discussed the critical roles specialists and caregivers during telehealth visits in long-term care settings. [WATCH TIME: 4 minutes]

Emphasizing a Team-Based Approach to Telehealth for Neurodegenerative Disorders in Long-Term Care: George Grossberg, MD

To navigate restrictions from the COVID-19 pandemic, a group of experts published recommendations on how to properly use telehealth to assess and manage psychosis-related symptoms for residents with neurodegenerative disorders in long-term care (LTC) facilities. There were several notable points that were considered essential to the success of this type of virtual care, including a collaborative effort between specialists, facility administrators, and facility staff. Another section focused on the best practices during evaluation and diagnosis, specifically harping on the need for specialists to actively solicit diagnostic information prior to and during these visits.

The study authors wrote that input from residents’ family members about long-term behavioral changes and other elements that staff might not observe or report is also useful to capturing a patient’s full experience. Similar to in-person evaluation, requesting previsit input from family members and LTC staff on their observations around the resident’s status may make the appointment more efficient and can aid in the diagnosis as well.

, the Samuel W. Fordyce professor and director, Geriatric Psychiatry, St Louis University School of Medicine, believes there are several ways to properly address these psychotic symptoms, including educating family and caregivers about asking the right questions. Grossberg sat down for a brief interview to discuss the most important information clinicians should keep track of when conducting telehealth visits, as well as the signs that may point to a patient experiencing psychotic symptoms.

Shaughnessy L, Brunton S, Chepke C, Farmer JG, Rosenzweig AS, Grossberg G. Using telemedicine to assess and manage psychosis in neurodegenerative diseases in long-term care. 

The director of Geriatric Psychiatry at the St Louis University School of Medicine discussed what clinicians should pay attention to when conducting telehealth visits for psychosis-related symptoms in patients with neurodegenerative diseases. [WATCH TIME: 3 minutes]

Soliciting Diagnostic Information From Patients With Neurodegenerative Diseases During Telehealth Visits: George Grossberg, MD

"What we found was that telehealth and the equipment that’s available to us was quite effective in being able to work with patients and families. In fact, it’s quite sensitive to picking up on disorders like psychotic symptomology early with the help of the professional caregivers in the nursing home and the help of family caregivers when we see patients in their own home."

The COVID-19 pandemic has forced the global implementation of telemedicine strategies, including in long-term care (LTC) facilities where people with dementia and other neurodegenerative conditions (PD) reside. To address these challenges, a multidisciplinary consensus panel was convened to develop best practices for LTC facilities and those who treat residents when utilizing telemedicine to care for residents with dementia-related psychosis or Parkinson disease-related psychosis.

Notable takeaways include the need for a multidisciplinary approach that involves a specialist, the LTC administrator, and staff. They panel also detailed the advantages and limitations of telemedicine and the best practices for how LTC staff and specialists can address technical challenges. The recommendations also touch upon both evaluation and diagnosis and why actively soliciting information before and during visits is crucial to the quality of patient-physician experiences.

Senior author George Grossberg, MD, the Samuel W. Fordyce professor and director, Geriatric Psychiatry, St. Louis University School of Medicine, sat down with 

 to discuss the reasoning behind the recommendations, advantages of telemedicine, and why there needs to be additional emphasis on psychiatric symptoms of neurodegenerative disorders as the pandemic continues.

REFERENCE
1. Shaughnessy L, Brunton S, Chepke C, Farmer JG, Rosenzweig AS, Grossberg G. Using telemedicine to assess and manage psychosis in neurodegenerative diseases in long-term care. 

The Samuel W. Fordyce professor and director of Geriatric Psychiatry at the St. Louis University School of Medicine discussed the motivation behind recently published recommendations for clinicians who treat psychosis in neurodegenerative diseases in a telemedicine setting. [WATCH TIME: 4 minutes]

George Grossberg, MD

Articles

Raising Awareness of Neuropsychiatric Symptoms in Neurodegenerative Diseases: George Grossberg, MD

Emphasizing a Team-Based Approach to Telehealth for Neurodegenerative Disorders in Long-Term Care: George Grossberg, MD

Soliciting Diagnostic Information From Patients With Neurodegenerative Diseases During Telehealth Visits: George Grossberg, MD

Using Telemedicine to Manage Psychosis in Neurodegenerative Diseases: George Grossberg, MD

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